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Vaccines and Chronic Disease |
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Clinical Trial: A Pilot Study of the Mechanism of Synergism between Fluticasone (FP) and Salmeterol in Preventing Chronic Obstructive Pulmonary Disease (COPD) Exacerbations
This study is currently recruiting patients.
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Purpose
| Condition | Intervention |
|---|---|
| Pulmonary Disease, Chronic Obstructive | Drug: fluticasone and salmeterol |
MedlinePlus related topics: COPD (Chronic Obstructive Pulmonary Disease)
Study Type: Interventional
Study Design: Treatment, Randomized, Open Label, Dose Comparison, Crossover Assignment, Efficacy Study
Official Title: A Pilot Study of the Mechanism of Synergism between FP and Salmeterol in Preventing COPD Exacerbations
Expected Total Enrollment: 14
Study start: January 2005; Expected completion: January 2010
Last follow-up: January 2008; Data entry closure: January 2008
Our objective is to examine the mechanism of the additive/synergistic properties of b2-adrenoceptor stimulation and corticosteroid receptor activation in:
- Preventing neutrophil adhesion to specific endothelial ligands, e.g. ICAM-1 and
- Undergoing activation as a consequence of this adhesion.
We hypothesize that combination therapy with salmeterol + fluticasone (FP) will:
- Augment the inhibition of adhesion of neutrophils obtained from the peripheral blood of study subjects in vitro, by blocking gIV-PLA2 translocation to the nuclear membrane as for eosinophils;
- Augment the inhibition of transendothelial migration of neutrophils into airways of subjects with chronic obstructive pulmonary disease;
- Augment the numbers and concentrations of pro-inflammatory products in the bronchoalveolar lavage fluid; and
- Decrease the number of neutrophils in the bronchial tissue of endobronchial biopsies of treated patients.
Eligibility
Inclusion Criteria:
- Males or females > 50 years of age
- Physiologic evidence of COPD defined per ATS guidelines as: cigarette smoking history >20 pack years, FEV1/FVC <70%
- Patients must have a post-bronchodilator FEV1 >50% of predicted value at enrollment
- Patient must have an O2 saturation measure by pulse oximetry >90% on RA
- Must be able to participate in the study, willing to give informed consent, and comply with the study restrictions
Exclusion Criteria:
- Women of child-bearing potential defined as females who are less than 5 years post menopausal unless they have had a hysterectomy or bilateral oophorectomy
- Observation of any solitary nodule in the lung requiring further medical intervention
- Patients on maintenance therapy with oral steroids
- Patients with giant bullous disease
- Significant other medical conditions, which in the opinion of the investigator, will interfere with the patient’s ability to perform the study tests
- Presence of a coagulopathy as defined by a platelet count <100,000/mm3, and PT and PTT >1.2 x the upper limit of normal
- Concurrent enrollment or participation in any other clinical trials within the past 30 days
- Primary diagnosis of asthma
- History of alpha 1 antitrypsin deficiency
- Any clinically significant and active pulmonary disease that could contribute to dyspnea
- Current systemic and inhaled steroids and theophylline
Location and Contact Information
Illinois
Department of Medicine, Pulmonary & Critical Care Section, The University of Chicago, Chicago, Illinois, 60637, United States; Recruiting
Alan Leff, M.D. 773-702-3609 aleff@medicine.bsd.uchicago.edu
Imre Noth, M.D., Principal Investigator
Alan Leff, M.D., Sub-Investigator
Imre Noth, M.D., Principal Investigator, University of Chicago
More Information
Publications
Soriano JB, Kiri VA, Pride NB, Vestbo J. Inhaled corticosteroids with/without long-acting beta-agonists reduce the risk of rehospitalization and death in COPD patients. Am J Respir Med. 2003;2(1):67-74.
Hanania NA, Darken P, Horstman D, Reisner C, Lee B, Davis S, Shah T. The efficacy and safety of fluticasone propionate (250 microg)/salmeterol (50 microg) combined in the Diskus inhaler for the treatment of COPD. Chest. 2003 Sep;124(3):834-43.
Hattotuwa KL, Gizycki MJ, Ansari TW, Jeffery PK, Barnes NC. The effects of inhaled fluticasone on airway inflammation in chronic obstructive pulmonary disease: a double-blind, placebo-controlled biopsy study. Am J Respir Crit Care Med. 2002 Jun 15;165(12):1592-6.
Kim YJ, Kim KP, Han SK, Munoz NM, Zhu X, Sano H, Leff AR, Cho W. Group V phospholipase A2 induces leukotriene biosynthesis in human neutrophils through the activation of group IVA phospholipase A2. J Biol Chem. 2002 Sep 27;277(39):36479-88. Epub 2002 Jul 17.
Chang PS, Absood A, Linderman JJ, Omann GM. Magnetic bead isolation of neutrophil plasma membranes and quantification of membrane-associated guanine nucleotide binding proteins. Anal Biochem. 2004 Feb 15;325(2):175-84.
Myou S, Zhu X, Boetticher E, Myo S, Meliton A, Lambertino A, Munoz NM, Leff AR. Blockade of focal clustering and active conformation in beta 2-integrin-mediated adhesion of eosinophils to intercellular adhesion molecule-1 caused by transduction of HIV TAT-dominant negative Ras. J Immunol. 2002 Sep 1;169(5):2670-6.
Reumaux D, de Boer M, Meijer AB, Duthilleul P, Roos D. Expression of myeloperoxidase (MPO) by neutrophils is necessary for their activation by anti-neutrophil cytoplasm autoantibodies (ANCA) against MPO. J Leukoc Biol. 2003 Jun;73(6):841-9.
Zhu X, Munoz NM, Kim KP, Sano H, Cho W, Leff AR. Cytosolic phospholipase A2 activation is essential for beta 1 and beta 2 integrin-dependent adhesion of human eosinophils. J Immunol. 1999 Sep 15;163(6):3423-9.
Meliton AY, Munoz NM, Liu J, Lambertino AT, Boetticher E, Myo S, Myou S, Zhu X, Johnson M, Leff AR. Blockade of LTC4 synthesis caused by additive inhibition of gIV-PLA2 phosphorylation: Effect of salmeterol and PDE4 inhibition in human eosinophils. J Allergy Clin Immunol. 2003 Aug;112(2):404-10.
Qiu Y, Zhu J, Bandi V, Atmar RL, Hattotuwa K, Guntupalli KK, Jeffery PK. Biopsy neutrophilia, neutrophil chemokine and receptor gene expression in severe exacerbations of chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2003 Oct 15;168(8):968-75. Epub 2003 Jul 11.
Record last reviewed: June 2005
Last Updated: June 30, 2005
Record first received: June 28, 2005
ClinicalTrials.gov Identifier: NCT00116402
Health Authority: United States: Institutional Review Board
ClinicalTrials.gov processed this record on 2005-07-05
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